【作者】 张航向；

【导师】 黄熙； 李源； 任平；

【作者基本信息】 第四军医大学 ， 中西医结合临床（内科）， 2001， 硕士

【摘要】 目的 从脾主运化与胃肠运动、胃肠激素的关系研究入手，探讨脾气虚证“脾虚失健运”在胃肠运动、胃肠电活动、胃泌酸、胃肠激素含量及其内分泌细胞等方面的变化，进而寻找“脾失健运”特异且客观的定性定量指标，为阐明脾气虚证本质提供新的客观依据。 方法 采用辨证与辩病相结合的原则，选择2000年3月至2001年2月间入住我校唐都医院消化内科符合脾气虚、胃热及肝火上炎证的患者，对其进行口服金属镁和乳果糖呼氢检查及胃电图检查；用放射免疫法（RIA）测定各组血浆及胃窦粘膜组织的生长抑素（SS）、胆囊收缩素（CCK）和胃动素（Mot）的含量，并应用免疫组织化学SABC法对其胃窦粘膜生长抑素细胞（D细胞），胆囊收缩素细胞（I细胞）进行染色，同时光镜下观察细胞形态和数量的变化。 结果 ①口服镁呼氢试验测定胃泌酸功能：脾气虚组的产氢量在15Min、30Min、45Min时均较胃热和肝火上炎组显著降低（13.16±4.51 ppmVS 34.21±6.86 ppm，22.35±5.17 ppm；14.33±4.18 ppm VS 37.25±8.27ppm，31.36±4.84 ppm；15.57±4.89 ppm VS 39.24±6.17 ppm，34.67±5.92 ppm）（P＜0.01），表明脾气虚证患者胃泌酸功能显著降低；②口服乳果糖测定小肠传递时间结果：脾气虚较肝火上炎组显著延长（125.6±21.3 Min VS 60.4±34.5 Min）（P＜0.01），脾气虚组和胃热组间无明显差异（125.6±21.3 Min VS 143.2±29.8）（P＞0.05）；表明在脾气虚证患者胃肠蠕动功能减弱，小肠传递时间延长；③脾气虚证患者和胃热及肝火上炎组比较胃电图波幅显著降低，胃电图频率明显增快（胃电图振幅：胃窦，60.4一士23．SuV VS 327．3土99．luV，246．4土56．ZuV，胃体，67．3士27．Zuv VS 286．4士69．4uV，217．5士60．4uV；孵：胃窦，3．4士0．3 VS 2．6士0．5，3．1土0．4，胃体，3．7i0．5 VS 2．5f0．3，3．1土0．3）（RO．05－0．of）。表明脾气虚患者胃电活动减弱，存在一定程度的电－机械脱偶联。④MOt、SS和CCK放免测定结果如下，与胃热和肝火上炎组比较：a．脾气虚证患者组织及血浆中 Mot 水平显著降低（胃窦组织：109．4士18．gng／g VS 219．8土25．3旭培，1％．0土23．9旭／g：血浆：61．7士10．6ng儿归171．4上3o．h叭，二扰．3土24．6ng几）（A0．01）：b脾气虚证患者血浆和组织中SS含量均显著升高（胃窦粘膜：224．3土67．gng／g VS 80．2土25．6ng／g，114．2士34．sng尔；血浆：74．5士17．Zng／L VS 30．3土＊．sng／L，38．l土12．7ng／L） （HO．01）；c脾气虚患者血浆和组织中CCK含量较胃热组显著升高（胃窦粘膜组织：34．二士5．Zng／g VS 21士4．7ng／g；血浆：5．8土0．4ng／L VS 3．7士0．6us／s）（RO．01），脾气虚患者血浆中CCK浓度较组肝火上炎组明显降低（5．8士0．4ng／L VS 7．9土0．sng／L）（HO．05）；脾气虚组以上胃肠激素在患者血浆和组织中浓度的改变，可以解释脾气虚证患者所出现的一系列临床表现，表明脾气虚证患者所出现的胃肠功能障碍与胃肠激素的改变相关。⑤免疫组织化学结果：a脾虚证患者胃粘膜组织D细胞数及D细胞强阳性率较胃热和肝火上炎组显著升高（阳性细胞数：70．4士10．IVS 38．1土 6．4，45．4上 8．6，”强阳性细胞率：43．2土 8．7 VS．9士 6．6，21．8士 7．5） （HO．of）；b脾虚证胃窦粘膜组织中I细胞数和强阳性细胞率较胃热和肝火上炎组均显著增高（阳性细胞数：S3．9士13．IVS 44．7士4．2，78．4士7．7，强阳性细胞率：31。5土5．7 VS 19．4土3．5，20．5士6．3）（HO．01－HO．05），这与患者血浆和组织中脑－肠肽的浓度改变一致，表明胃肠粘膜组织合成和分泌细胞功能的改变，是患者脑－肠肽浓度变化的直接原因。 结论①我们首次观察了脾气虚证患者胃粘膜组织中D细胞、I细胞的变化，发现在脾气虚证患者胃窦粘膜D细胞增生，合成分泌SS功能活跃， 5一分泌CCK的1细胞增生，功能活跃，这可能是导致脾气虚时胃肠功能紊乱的重要病理因素之一，同时也为脾气虚状态时胃窦粘膜内分泌细胞的改变提供了形态学依据，对脾气虚证的微观辨证具有重要价值；②有关脾气虚患者血浆和组织中CCK浓度的变化尚未见报道。我们观察到脾气虚证患者血浆和组织中CCK含量升高，结合观察到的SS和M叭含量的变化，能较好地解释脾虚状态时所弓I起的消化系统功能低下的病理过程，尤其是 SS和MOt的改变特异性较好，提示SS含量升高、M。t的含量降低不失为脾气虚证临床辨证的客观定量指标：③研究提示脾气虚证患者临床出现的一系列症状如腹胀、纳差、乏力、便搪等可能与患者胃泌酸功能减退、胃肠蠕动功能减弱、胃电波幅降低有关。而胃肠激素内分泌细胞数量和功能的变化所引起的胃肠激素在组织和血浆中浓度的紊乱在其中起着重要的作用。更多还原

【Abstract】 Aim: To investigate the relationship of "dysfunction of the spleen in transport" with gastrointestinal movement, electrogastrography, gastric acid secretion, brain-gut peptide and their enteroendocrine cells-, Search for an objective index with high specificity and sensitivity to provide new clinic evidence for elucidating the essence of spleen-asthenia syndrome.Methods: The patients of Spleen-Asthenia syndrome(SA), Stomach-Heat (SH) , Flaming-Up of Liver-Fire (FULF) were selected in department of Gastroenterology from Mar. 2000 to Feb. 2001, having examined their breath hydrogen test(BHT)r Electrogastrography and analyse the results; The concentrations of somatostatin(SS), motilin(Mot), Cholecystokinin (cck) in tissue and plasma were measured by radioimmunoassay(RIA); Moreover immunohistochemical SABC method was employed to stain the D cell and I cell of gastric antrum. The variation of appearance and quantity of endocrine cells was observed by light microscope.Results (D In the group of SA, compared with groups of SH and FULF, the H2/excess during oral magnesium BHT reduced at 15Min,30Min,45Min (13.16?.51ppm VS 34.21?.86ppm,22.35?.17ppm;14.33?.18ppm VS 37.25 ?8.27ppm,31.36 ?4.84ppm ; 15.57 ?4.89ppm VS 39.24 ?6.17ppm,34.67?.92ppm) (PO.01), the result indicated that the function of gastric acid secretion reduced markedly in patients with SA; (2) The results of small bowel transit test(SBTT) after oral lactose BHT, compared with the groupof FULF: the time in groups of SA was increased (125.6 + 21.3Min VS 60.4 ?34.5Min) (PO.01), the times are not difference between SA and SH (125.6 ?1.3MinVS 143.2 + 29.8 Min) (P>0.05) , this indicated the gastrointestinal movement reduced and the SBTT increased. ㏕he electrogastrography amplitude reduced and frequency increased in group of SA compared with groups of SH and FULF (amplitude: gastric antrum: 60.4 + 23.8uv VS 327.3 ?9.1uv, 246.4?6.2uv, gastric body.- 67.3?7.2uv VS 286.4?9.2uv, 217.5 + 60.4uv; frenquency: gastric antrum: 3.4?.3 VS 2.6 + 0.5, 3.1+0.4, gastric body: 3.7 + 0.5 VS 2.5 + 0.3, 3.1 ?.3) (P<0.01).this indicated EGG reduced in patients of SA. ?The radioimmunoassay results: compared with groups of SH and FULF, a. In the group of SA, the levels of Mot in gastric antrum mucosa and plasma reduced^O.Ol) (gastric antrum: 109.4+ 18.9ng/g VS 219.8 + 25.3ng/g,183.0 + 23.9ng/g; plasma: 61.7+10.6ng/L VS 171.4?30.8ng/L,126.3?4.6ng/L; b. In the group of SA, the levels of SS in gastric antrum and plasma increased(P<0.01) (gastric antrum: 224.3 + 67.9ng/g VS 80.2 + 25.6ng/g, 114.2 + 34.5ng/g; plasma: 74.5 + 17.2ng/L VS 30.3 ?11.8ng/L,38.1 + 12.7ng/L); C. In the group of SA, compared with groups of SH, the levels of CCK in gastric antrum and plasma mcreased(P<0.01) (gastric antrum: 34.1?.2ng/g VS 21.6+4.7ng/g; plasma: 5.8+0.4ng/L VS 3.7?0.6ng/g); In plasma, the level of CCK in group of SA is lower than group of FULF (5.8 + 0.4ng/LVS7.9?.8ng/L) (P<0.01) . The changes of brain-gut peptide in tissue and plasma could explain the serial of symptom about dysfunction of the spleen in transport. ㏕he results of immunohistochemial SABC: a. In the group of SA, compared with groups of SH and FULF, the number of D cell and the percentage of strong positive cells increased markedly in gastric antrum (P<0.01)(the quantity of positive cells: 70.4?0.1 VS 38.1 + 6.4, 45.4+8.6, percentage of strong positive cells: 43.2?.7VS 17.9 + 6.6, 21.8?.5); b.Inthe group of S A, compared with groups of SH and FULF, thequantity of I cell and the percentage of strong positive cells markedly reduced in gastric antrum(P<0.01) (the quantity of positive cell: 44.7+4.2 VS 83.9 + 13.1, 78.4 + 7.7, percentage of strong positive cells: 19.4 + 3.5 VS 31.5 + 5.7, 20.5?.3)(P<0.01-P<0.05)), the quantity of I cell in group of FULF was more than that in group of SH(P<0.01), these indicated the change of D and I cell in gastric antrum were the direct reasons that brain-gut peptide changed in tissue and plasma.Conclusions:e researched firstly the relationship between D,更多还原